Is the Customer Really Always Right?

It may seem outrageous to those in the customer service business, but the answer is most definitely “no.” Nowhere in the call center industry is this more evident than in insurance claims support scenarios. The need for insurance of some description is one of those morbidly certain things in life like death and taxes. Unfortunately, insurance is arguably more complex than the other two put together, which makes customer support in the insurance contact center quite the challenge (that’s putting it lightly.) But whether it’s an insurance customer or a retail customer who didn’t read the return policy or a consumer with a complicated warranty situation for a high-value purchase like a vehicle, sometimes the customer is just wrong and it takes a particularly skilled and well-trained call center agent to create a positive experience from that foundation.

As a long-time customer support partner for one of the largest travel insurance providers in the world, we have deep experience supporting the customer who incorrectly believes he’s covered when he’s not. The familiar mantra of “the customer’s always right” heard in many other customer-centric sectors simply does not translate well to insurance. In fact, with lengthy and complex policies in play – the customer is often “wrong” about the details of their coverage. So how do we engage and support these customers without turning them off?

Why the Customer Gets It Wrong

Let’s look at this idea of the customer being wrong from the insurance perspective: even basic travel insurance policies come with some 18 pages of small print explaining the terms and conditions of the policy. (Much like the world of warranties.) If you’ve read every word of every policy you’ve ever bought, you deserve a medal. It’s a rare soul who can stomach all the legal and industry language that fills every inch of those pages.

Add the fact that every individual policy is different from the next, and the reality is that very few people take the time to fully comprehend exactly what they’re getting when they sign on. The basics, sure – most people have a good handle on the broad terms of coverage. But when something unusual or complex happens, the ultimate impact of this lack of understanding lands directly on the claims department. Claims that have been denied represent one of the most complex area of insurance customer service, where agents must explain to customers why a claim has been rejected when the customer believes their claim is valid.

Here’s a good example: An irate customer recently called us to dispute a claim rejection. More than a year earlier, our customer had purchased travel insurance for an expensive trip to Hawaii with his wife. However, life happened between the time of booking and the planned date of departure, and the couple were now going through a divorce. Our customer understandably cancelled the trip. It was this customer’s belief that his investment in the vacation would be covered by his trip cancellation insurance. But the policy he’d purchased to cover the trip did not include divorce as an eligible reason for reimbursement. He believed his reason was valid; it was our job to help our customer understand his policy and accept the reality that he was not covered. That is an especially challenging scenario for any agent – anyone with a heart can understand how upsetting this situation was for the customer and yet, the customer was wrong about his coverage. Success came from guiding the policy owner through to the relevant terms of his policy, clearly illuminating those terms in a way the customer could understand, and not becoming emotionally involved.

How to Tell a Customer They’re Wrong

We’re all familiar with angry customers. When people believe that their travel plans, cars, health, and more are insured against any number of adversities, only to find out they’re not, that’s a recipe for disappointment, disbelief, and pure anger. And so they pick up the phone and call us.

Helping a customer understand that they’re wrong essentially requires a non-emotional response that taps into assisting and enlightening instead of sympathizing. Agents need to stay far away from phrases such as, “I completely agree with you,” “I feel your pain,” and “I’m sorry to hear this.” These are sympathetic phrases that could mistakenly lead the customer to believe they are, in fact, in the right.

While an agent does need the ability to put themselves in the customer’s shoes (i.e. having empathy), the primary focus should be on educating the customer about their policy. Doing this successfully begins with building the right agent profile. Ensuring that the people you’ve hired have the right natural attributes to stay measured and calm, to not take anger personally, to communicate clearly and effectively is essential.

How to Train Contact Center Agents to Say No

With the right people in place, the focus moves to training. When your agents are supporting complex issues like insurance claims or warranty validation claims, they have to be the ultimate experts. Thorough training on the nuances of both products and processes is essential. Role play (including live call role play) and effective testing for applied knowledge are essential elements of training for these scenarios. (Our training is based on the philosophy that no one should be able to get 100% on a test and 0% on a call. In other words, an agent’s most challenging call should be easier than the tests they faced in training.)

We audit our training programs twice a year (and our own training has been audited and found to be exceeding industry standards by JD Power.) The focus of the training program audit is to ensure that the training plan is balanced: no one is going to experience death by PowerPoint; agents are challenged with hands-on work that simulates the production floor; testing happens at regular intervals and includes cumulative assessments; and role play is never overlooked. In our world, role play takes two forms: side-by-side role play in the classroom and live call role play with “mystery callers” dialing in to the training environment. In the latter scenario, you can simulate the stress and discomfort of an agent’s first few calls before they actually take a customer’s call. We ensure that live call role plays involve personnel that the agents don’t know calling in on our role play phone line. If an agent knows it’s his trainer on the phone, the stress level goes way down. If he has no idea who is on the phone, the pressure increases.

The investment you make in upfront training is an investment in long-term customer loyalty. Armed with deep knowledge – and the confidence that comes with competence – your agents can then interpret the customer’s policy at a human level. This means that dialogue with the customer begins with guiding the customer through their policy and addressing the customer’s concern using relatable context and language. It’s the agent’s goal to make it clear exactly what the policy entails and which section reflects the decision that was made. Doing this in a way that creates a positive experience for the customer is a delicate dance. Too much empathy and the customer still feels “wronged” – too little and the customer doesn’t feel valued. It’s about the agent creating trust and acting as an informed consultant and advisor rather than an advocate for “making it right.” And that’s counter-intuitive to most call center jobs.

A large chunk of an agent’s onboarding time should be dedicated to Policy Interpretation training. They need to build a thorough understanding of the industry terminology and policy language and what it all means in layman’s terms.

The second key part to agent training is in how to deliver a positive customer experience even though the customer isn’t getting what they want. Essential to this process is understanding the customer journey map and uncovering a customer’s motivations behind making the call. Some customers are all too ready to start a shouting match, and it’s the agent’s job to prevent the call from getting too heated. This is where empathy, not sympathy, is once again key. Oftentimes, the customer just wants to know they’re being heard.

Finally, it’s valuable to provide agents with continual coaching in professionalism. The agent must be trained not take someone’s inflammatory comments personally or offensively. And it’s not about avoiding confrontation, either; it’s about taking a firm stand while simultaneously letting the customer know the agent is genuinely listening to their concerns.

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Wrapping It Up

At the end of the day, you don’t want to lose a customer because of a bad experience with the contact center. It requires a skilled, diplomatic, confident individual to educate the customer on complex policy and warranty issues while also ensuring they feel heard and valued. To achieve that careful balance, you need an experienced contact center partner that fully comprehends the complexities of your industry, from insurance, to automotive, to high-value retail. Contact us today to learn more about how we can help you.

Kim Campbell joined Blue Ocean in 2002 and she has had senior project management responsibilities for many of Blue Ocean's top clients. In her role as Vice President, Operations, Kim is responsible for overall project management structure and the delivery of Blue Ocean's value proposition with a focus on shared resources and financial metrics.

1 COMMENT

Hi Kim, interesting article, but imo a wrong premise. In your scenario the customer is not lost because of the contact centre but because of all the non intelligible legalese of the insurance company. The call center agents have a hard time making something that is entirely customer unfriendly all of the sudden customer friendly. With short and understandable t&c things would be far smoother and probably far more profitable for the companies, saving them gazillions on lawyers and support cost.

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